June 16th, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-As the effects of gravity, aging and sun damage take place, one of the first places to show the effects is the eyes and the brow. The brow lift has one of the highest rates of patient satisfaction. Having just a brow lift can refresh the face with a subtle yet elegant result.
Depending on the patient, there are different variations to the brow lift. It is not uncommon for some men and women to have eyebrows naturally at different heights, with a brow lift they can be made more symmetrical. The brow lift can be combined with other procedures such as a facelift, eyelid surgery, nose reshaping and some patients choose to have it combined with breast surgery or tummy tucks.
The least invasive brow lift would be the temporal brow lift, also known as the lateral brow lift. This procedure is more for the patient that has mild to moderate descent of the brow. The incisions are small and made at the temple region of the forehead and scalp, some of the scar may be visible on the side of the forehead, not always as hidden as desirable. There isn’t any muscle reconstruction involved, only tightening and excising some skin.
The temporal brow lift only addresses the outer third of the eyebrow. When aging causes the brow to sag, it gives the face a sad, tired or surly appearance. Ideally the tail of the brow should be a little higher than the medial end (next to the nose) with a gentle arch in the middle. Recovery is faster with less bruising and swelling, but it will not correct wrinkles of the forehead or the glabellar frown lines between the eyes.
The coronal brow lift (also known as the “open brow lift”) is considered the gold standard of brow lifts and has been around the longest. This procedure is made with an incision that goes across the top of the head from ear to ear within the hairline. This approach allows the surgeon full access to the forehead musculature for complete elevation of the brow and forehead. This procedure is the best for patients that have high foreheads, so they are not made even higher. The coronal brow lift is also considered the longest lasting. There are some downsides to the procedure, the scar on the top of the head can widen, there can be hair loss, and with the cutting of nerves on the top of the head there may be permanent numbness.
Then we have the evolution of the endoscopic brow lift. The goal was to have a procedure that could get the same result as the coronal approach without the invasiveness.This is my preference for brow lift procedures when all aspects have been considered; I have been doing it since its beginning, with the exception being the patient with an already high forehead, then the coronal approach is best. The endoscopic brow lift is along the same incision line as for the coronal lift except that instead of a long incision there are five small incisions about ½ inch in length behind the hairline. The hair is parted, not shaved for the procedure. The endoscope is an instrument with a tiny camera that is inserted through small incisions allowing the surgeon to see images on a TV monitor.
You will find that different surgeons have different preferences based on what procedures they are trained in and feel comfortable with. I recommend that first you make sure you are seeing a Board Certified Plastic Surgeon and request to see many before and after pictures of that surgeon’s actual patients.
Many people are fearful of the brow lift procedure after seeing many celebrities that have had it done and have a surprised or startled look. This is unfortunate because if the surgery is done properly it is one of the most rewarding procedures done. My goal is for the patient not to have an “operated” look if anything I’d rather mildly under correct than over correct the brow, and I achieve this by making precise measurements pre-operatively.